Provider Demographics
NPI:1952677379
Name:KISHOR D POPAT, MD, A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:KISHOR D POPAT, MD, A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KISHOR
Authorized Official - Middle Name:D
Authorized Official - Last Name:POPAT
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:805-922-6990
Mailing Address - Street 1:1505 SHEPARD DR
Mailing Address - Street 2:STE 203
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7020
Mailing Address - Country:US
Mailing Address - Phone:805-922-6990
Mailing Address - Fax:805-347-9920
Practice Address - Street 1:1505 SHEPARD DR
Practice Address - Street 2:STE 203
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7020
Practice Address - Country:US
Practice Address - Phone:805-922-6990
Practice Address - Fax:805-347-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39601207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty